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SAMPLING INFORMATION SHEET <br /> Client : <br /> u-( <br /> � <br /> site : Sampling Date: `_�0_.°Y1�2n �^ � � <br /> Project No. : <br /> Well Designation: b7'-2, <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? 2 <br /> Is top of casing cut level? YES Above TOC Selow TOC <br /> Is well cap sealed and locked? ,NO )Z� If no, see remarks <br /> Height of well casingriser 1 YES If no, see remarks <br /> (in inches} : <br /> Well cover type : 8" W 12" UV 12" EMCO �� <br /> 12 " BK 12" DWP „ 8 BK <br /> 12" CNI 36 CNI ther <br /> General condition of wellhead as Excellent Goo Fair Poor <br /> Purging Equipment : 2 " disposable bailer <br /> „ Submersible pump <br /> 2 PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer Teflon bailer: <br /> Well Diameter : 2"� 4 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 7 0 . 65 1 . 47 2 . 51 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time : 1�2 0� _ Time : Calculated purge <br /> Depth of well : GFS / Depth to water -ow <br /> : <br /> Depth to water : Actual purge ;-o_ <br /> it15.�� <br /> Start purge : / Sampling time : E T <br /> Time Temp. E. C. pH Turbidity Volume <br /> ) 41-1- 726 -� <br /> ` 4 'fJ 7b.5 <br /> L -�J- <br /> Sample appearance : Lack : <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap : Lock #3753 • 7/32 Allenhead: <br /> 4 '' Locking Cap : Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> f.. <br /> Signature : <br />